P1519: MULTICENTER STUDY OF SARS-COV-2 INFECTION IN PATIENTS WITH HEMATOLOGICAL DISEASE: VACCINATION, ANTIVIRAL THERAPY, RISK FACTORS, AND OUTCOMES IN TAIWAN
Authors: Huai-Chueh Gem Wu, Ling-Jung Chiu, Tung-Liang Lin, Yuen-Chin Ong, Ming-Chung Kuo, Yen-Min Huang, Jin-Hou Wu, Hsuan-Jen Shih, Ning-Chun Chen, Yu-Shin Hung, Hung Chang, Ming-Chung Wang, Hsiao-Wen Kao
Journal: HemaSphere (2023)

Topic: 30. Infections in hematology (incl. supportive care/therapy) Background: Patients with hematological diseases (HD) have lower antibody responses to vaccination, a higher risk of SARS-CoV-2 breakthrough, severe infection, and increased mortality during SARS-CoV-2 infection. Aims: We aim to present the clinical features, outcomes, and risk factors of HD patients with SARS-CoV-2 infection in Taiwan during the period when vaccination, monoclonal antibodies, and antiviral agents were available at multiple medical centers. Methods: Adult HD patients who tested positive for SARS-CoV-2 between May 2022 and January 2023 from multiple medical centers in Taiwan were retrospectively enrolled. HD included AML, ALL, lymphoma, MM, MDS, MPN, CLL, and benign HD. Clinical variables such as age, sex, comorbidities, vaccination status, disease status/treatment of HD, severity, and the use of antiviral agents were collected from medical records. Outcomes were evaluated for all-cause mortality, ICU admission, organ failures, thromboembolism events, additional infections, and duration of viral shedding. We assessed the impact of clinical variables on outcomes, including all-cause mortality, ICU admission, organ failures, thromboembolism events, additional infections, and duration of viral shedding. Results: 163 patients were included in the analyses, with a median age of 60 years (range 20-94). 57.1% (n=93) of the population were male. Patient populations consisted of lymphoma (41.1%), AML (26.4%), MM (4.9%), MPN (4.3%), ALL (3.7%), MDS (3.1%), CLL (1.8%), and benign HD (6.8%). 47.9% of patients had active HD and were receiving HD treatments, including intensive chemotherapy (18.4%), immunochemotherapy (28.8%), low-intensity therapy (14.1%), oral target therapy alone (8%), immunosuppressants (6.1%), B-cell depletion therapy (32.5%), or hematopoietic stem cell transplantation (HSCT, 3.1%). 64.4% of patients were adequately vaccinated (≥ 2 doses). 76.9% of patients received anti-viral therapy (Nirmatrelvir + ritonavir, remdesivir, or molnupiravir). Viral shedding lasting more than 14 days and more than 30 days occurred in 59.2% and 18.2% of HD patients, respectively. 17.1% of patients had severe SARS-CoV-2 infection. Patients experienced complications, including bacteremia (12.3%), bacterial pneumonia (12.9%), fungemia (1.2%), CMV viremia (6.1%), bleeding events (11%), and thromboembolism events (3%). The 30-day and 60-day mortality rates were 11% and 16%, respectively. Risk factors associated with increased mortality were platelet count < 50,000/uL (HR 2.8, p = 0.009), D-dimer > 5000 ug/L (HR 3.6, p = 0.008), and IgG < 700 mg/dl (HR 6.8, p = 0.015). Factors associated with viral shedding > 14 days included neutrophil count < 500/uL (p = 0.03) and platelet count < 50,000/uL (p = 0.035). B-cell depletion therapy was associated with a trend of prolonged viral shedding > 30 or > 60 days (p = 0.069). Summary/Conclusion: The study found that mortality and severity of COVID-19 in HD patients were lower than in previous cohorts, possibly due to variants with lower virulence, vaccination, antiviral therapy, and infection precautions. However, over 50% of HD patients experienced prolonged viral shedding, raising concerns about transmission, late complications, and treatment delays/modifications for HD.Keywords: B cell depletion, Vaccination, COVID-19, Immunodeficiency